Fractures of the pelvic ring account for approx. 4 percent of all fractures. This injury is found in 25 percent of patients who suffer serious accidents (high-energy impact injuries: road accidents, falls from great heights).
Bleeding occurring in the vicinity of unstable pelvic ring fractures may be difficult to control. It can be so profuse that the patient’s life is in grave danger. In these cases, the pelvis must be stabilised immediately. The urinary tract is also at risk due to its proximity to the site of the injury. Older patients frequently suffer so-called “stable fractures” (more than 50% of pelvic fractures) as a result of a fall (low-energy trauma).
The forces involved are:
A distinction must always be made between stable and unstable pelvic fractures. Important:
There are various classification systems; ultimately, however, they all distinguish between stable, rotationally unstable and rotationally/vertically unstable.
Stable injuries include fractures or avulsion of the iliac wings, ischium, pubis or coccyx below the articulated joints which do not affect the stability of the pelvic ring. These injuries can often be treated without surgery. The priorities in such cases are pain management and patient mobilisation.
Combined injuries are the most unstable of all. They are frequently combined with additional injuries to the skeletal system and other body parts. The anterior and posterior structures of the pelvic ring are both affected. Surgery is essential in the case of rotationally and vertically unstable fractures. Depending on the injured patient’s condition, emergency external stabilisation is performed using an external or internal fixator before the definitive treatment is administered (commonly plates or screws).
Left: Computed tomography following avulsion injury of the first sacral vertebrum. Right: Postoperative x-ray following minimally invasive stabilisation using long screws inserted through small incisions in the skin.
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University Hospital Zurich
Department of Traumatology